To the Editor.—Immune surveillance is the mechanism by which the immune system is thought to monitor tissues for evidence of malignant transformation.1 Twenty years have passed since it was first confirmed that prolonged iatrogenic immunosuppression, as in renal transplant recipients, results in an increased incidence of skin cancer.2 We report the first case of common variable immunodeficiency (a primary immunodeficiency) associated with multiple squamous cell cancers of the skin.

Report of a Case.—A 48-year-old white woman first presented to the Lahey Clinic, Burlington, Mass, in 1971 with a history of deafness from recurrent ear and mastoid infections, recalcitrant pneumonias, and diarrhea. In 1977, serum protein electrophoresis revealed agammaglobulinemia. In 1980, after suffering from recurrent respiratory infections and a bowel infection with Giardia lamblia, monthly injections of gammaglobulin were begun. At that time, the leukocyte count and cell differential were normal. The absolute number of